MEDICARE: BETH E HABERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	36541	KY
2	208000000X	Pediatrics Physician	36541	KY
3	2080N0001X	Neonatal-Perinatal Medicine Physician	36541	KY
4	2080N0001X	Neonatal-Perinatal Medicine Physician	35067806	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184617946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH E HABERMAN MD

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 7009
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-4830
Fax Number	:	513-636-7868

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 7009
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-4830
Fax Number	:	513-636-7868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/14/2010

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Directions to “ BETH E HABERMAN MD” Practice Location

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